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Ritalin and similar medications cause brain to focus on benefits of work, not costs


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  • 3 weeks later...

Something must be wrong with my brain or my stimulant choice or dose, because literally all I can focus on is the costs of doing something and how much I don't feel like doing anything.

I mean, without my Dexedrine, I'm hopeless, but with it, I'm slightly less hopeless.

Edited by mikl_pls
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3 hours ago, notloki said:

And you are at the limit set by your doc, right ? 60 mgs a day total. How was methamphetamine ? In theory it is a stronger stimulant, the strongest available. 

Yep. 60 mg/day d-amphetamine. Methamphetamine was truly an awful experience both times. I got to 15 mg/day (the utmost maximum my pdoc was willing to go both times I tried it) and I was crying for no reason, extremely tired all the time, and extraordinarily depressed. I think maybe there's a chance I may have been under-dosed (usual ADHD range is 20-25 mg; for sleeping disorders, it's higher, like 40-60 mg up to even 100 mg/day, but good luck trying to get a PA from any physician of any kind for Desoxyn for any dose above the max, and good luck getting it to go through with the insurance... right?)

The only doctor who was willing to even remotely consider prescribing it (Desoxyn) was my pdoc, and she has developed a rather rotten attitude about prescribing stimulants to me since we had that big argument about dosing of stimulants (Adderall vs Dexerdine, how she gave me Adderall XR 90 mg, but refused to give me any more than Dexedrine 30 mg for some weird reason, and I called her out on it and she git pissed... Since then, I have seen my NP/gdoc for my stimulant... and they were willing (especially when I saw my NP) to go beyond the 30 mg/day limit...)

All that being said, I'm really not super anxious to try Desoxyn again anytime soon. I'm actually sorta considering going to Adderall. I have been reading that the presence of l-amphetamine (in the racemic amphetamine in Adderall or even in Evekeo) is better for promoting/enhancing sustained attention for difficult tasks, which is what I feel I have more trouble with, whereas d-amphetamine seems to be better at controlling hyperactivity and impulsiveness (the former of which I have the exact opposite problem now--I'm extremely hypoactive, but I do have some rather serious impulsiveness issues still, although not nearly as bad as they used to be when I was still on Abilify, particularly in the 20-30 mg range, which absolutely ruined me financially). My pdoc has told me that she believes I'm the primarily inattentive presentation of ADHD, whereas when she first started seeing me, she had me down as the combined presentation. So from the article I read about l-amphetamine and other articles dancing around that very same point (instead of point blank saying it like this article did), I'm starting to think that either Adderall or perhaps even Evekeo would be better for my presentation of symptoms (for ADHD anyway...). I also kind of pondered adding a very low dose (5-10 mg/day) of oral selegiline (Eldepryl) simply for the l-amphetamine (mostly) and l-methamphetamine (not as much) metabolites (which, with the Emsam patch, even though the levels of selegiline in the brain are much higher and would make more sense to take as a replacement antidepressant, the amount of amphetamine metabolites are much, much lower, almost negligible, due to the bypassing of first-pass metabolism in the liver). I don't know if either my pdoc or my gdoc/NP will go for that idea though.

As for my idiopathic hypersomnia, I'm really not sure which would be a better wakefulness promoting agent (pure dextro, mixed, or pure racemic...). I've tried both Provigil (up to 400 mg/day) and Nuvigil (up to 250 mg/day) in addition to pretty high doses of both Dexedrine and Adderall without any benefit. I don't think I'm a responder to either Provigil or Nuvigil at all. I've also tried augmenting with up to 80 mg Strattera, which I read is supposed to help with wakefulness, and it didn't do much except make me relapse back into a psychotic depression when I transitioned from the titration pack to the generic atomoxetine that literally came out the week I filled the Strattera prescription. (My pdoc told me I was definitely not the only one complaining about generic Strattera... but with my insurance, there's no way to get brand-name if there's a generic... they give zero damns or fucks...) Vivactil (secondary amine TCA) is actually pretty stimulating (probably more stimulating than Strattera ever was) at just 30 mg/day, but the anticholinergic side effects inevitably get to me over time (urinary retention/hesitancy and blurry vision up close/inability to focus up close especially, but with the very strange side effect that seemingly almost all TCAs are capable of causing in both men and women of spontaneous orgasms... it usually tends to be imipramine or clomipramine for most, but I guess for me it's protriptyline...). I'm on Norpramin (desipramine) and I've taken it up to 200 mg/day and it's nowhere at all near as stimulating as Vivactil for some reason, despite being a more selective and potent NRI than Vivactil (fortunately or unfortunately, no spontaneous orgasms... lol). Either way, I think that having a secondary amine TCA on board increasing the NE in my brain may help with the inattentive symptoms of ADHD (key word may), as that is what l-amphetamine seems to boost more (it has effects on dopamine too for sure, but they are different than those that d-amphetamine has, mostly in their kinetics...) Plus NRIs increase DA in the PFC too, blah blah blah.

I'm not much of a fan of the SNRIs (too much serotonin activity, and Fetzima makes me feel miserable). Cymbalta is okay, but the serotonergic effects at the dose that I need to be effective for me (120 mg) are palpable (sexual side effects, weight gain instead of the usual weight loss that Cymbalta causes). Effexor XR is extremely rough for me in side effects, even in low doses (mostly extreme sexual side effects, constipation, and extreme weight gain). Pristiq doesn't do anything at all for me, no side effects, no benefits, even at doses above 100 mg/day. And like I said, I prefer to stay away from Fetzima after my numerous trials of it.

I have found that combining an SSRI (my favorite being Zoloft) in low to moderate doses with a secondary amine TCA (my favorites being desipramine and protriptyline, the latter now being almost impossible to find anywhere...) has better effects for me, because I can pretty much "customize" the SRI-to-NRI ratio as needed. Since starting Caplyta, which has SSRI effects built-in, I have lowered my Zoloft to 100 mg, and may consider lowering it further and maybe even discontinue it. To make up for it, I may consider increasing my desipramine or, if my pdoc will let me, switch to protriptyline (she has been policing me on switching meds as often lately... or even changing doses...) She does not like prescribing the TCAs at all... she prefers to keep them at super low doses if she prescribes them at all. She would rather me switch to Strattera, but... no thanks... Of the TCAs, nortriptyline is her favorite to prescribe (it's supposedly the safest?), and that one has never had any effects on me at all. She prefers to keep the dose at 50 mg/day no matter what, but I have taken it to the max of 150 mg on my own before for several weeks out of desperation (bad patient, I know), and only then did I start to feel a little bit of something, but the antihistaminergic and anticholinergic side effects were a bit much at that dose, as well as weight gain becoming a problem (which has never been a problem with desipramine or protriptyline at any dose).

I think I have digressed way off topic... I do that quite a lot...

Anyway... as for stimulants... Currently on Dexedrine, thinking it might actually be causing me to be a little "hypoactive" (a little too controlled on the hyperactive symptoms) and not controlling my inattentive symptoms nearly enough. Nothing I don't think will ever control my impulsive symptoms enough... ever... Considering Adderall or maybe even Evekeo (likely won't try because my insurance doesn't cover it anymore, and I'd have to get a PA just to get it covered, and who knows how expensive it'd be then...) I think Adderall at 60 mg/day + maybe low dose oral selegiline to boost the presence of l-amphetamine would possibly help? Maybe a little bit much? Maybe I could get my gdoc/NP to agree to go past the typical max of 60 mg more easily with Adderall than I could with Dexedrine, and possibly mitigate the quantity limit by combining Adderall with Adderall XR (more expensive with two prescriptions, but... whatever works...) As I said above, I strongly disliked Desoxyn both times I tried it (more the second time I think than the first time). I actually hated it so much the second time that I brought the bottle back to my pdoc before my next appointment and told her I couldn't take it or tolerate it (she takes custody of and properly disposes of controlled substances like that), and she put me back on the Dexedrine 30 mg/day I was on before going on the Desoxyn the second time.

I have tried to get a prescription for that new narcolepsy med, Wakix, which I think is an H3-agonist? My NP didn't understand how to properly prescribe it... He didn't know it was distributed by their own special pharmacy, for which you fill out a special form from their website for the prescription and fax to their pharmacy, rather than printing a regular prescription to be filled at just any pharmacy. He didn't ever follow up with that after I told him what he needed to do to actually prescribe it. He briefly considered Sunosi, but neither he nor I are very excited about it/think it would help much... I have briefly considered switching to any form of Ritalin, so long as I am "properly" dosed (i.e., 60 mg/day or more to match my Dexedrine dose, but unlikely I would ever go above the 60 mg max, unless I somehow get Jornay PM or Adhansia XR covered by my insurance). Have also wondered how Xyrem would help me by consolidating my sleep better/improving the quality of my sleep at night, but I have heard pretty nasty things about Xyrem from a friend of mine who took it for a while.

I think I'll end this wall of text here while I can... lol.

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